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❑Keller Canyon ❑COffin'BUtte ❑Ox Mountain ❑Newby Island Forward <br /> Sanitary Landfill Landfill Sanitary Landfill Sari ,:y Landfill Landfill <br /> 901 Bailey Road 28972 Coffin 8QRoad 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin,Road <br /> Pittsburg, CA 94565 Corvallis, OR 97330 Half Moon Bay, CA 94019 Milpitas, CA 95035 Manteca, CA 95336 <br /> ,�,*--Phone (925)458-9800 Phone(541) 745-2018 Phone (650) 726-1819 Phone (408) 945-2800 Phone (209)'982-4298 <br /> Fax (925)458-9891 Fax (541)745-3826 Fax'(650) 726-9183 Fax (408)262-2871 Fax(209)982-1009 h <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> (LING ADD ESS _ ��®� <br /> 20500 8ar�Ho }hive r <br /> CITY, STATE, ZIP REQUIRED PERSONAL'PROTECTIVE EQUIPMENT <br /> nIMCA 95304 <br /> PHONE CXGLOVES ❑ GOGGLES LJRESPIRATOR 30 HARD HAT <br /> (209)83441579 ❑TY-VEK [XSAFETY VEST <br /> CON ACT PERSON <br /> eO SPECIAL HANDLING PROCEDURES: <br /> ArmSIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S CFRTIFICATIM I hereby certify that the above na ed materiat is not a hazardous ` <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been property rl <br /> described,classified and packaged,and is in proper condition for transportation according to applicable <br /> regulations;AND,If the waste is a treatment residue of a previously restricted hazardous waste <br /> subject to the Land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> ' <br /> _.accordance with the,requirements_oi AD.CFR_P_art.268 and.is.no longer a hazardous waste as defined by <br /> 40 CFR Part 261. <br /> WASTE TYPE:. <br /> ❑CONSTRUCTION ❑WOOD <br /> ❑DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> 20500 SoUdi Hotly Drive TIt�iCY <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS' !!V <br /> C <br /> T43di.ir.A Q5241 <br /> PHONE,--- END_D.UMP. __.BOTTOM.DUMP._ TRANSFER <br /> El Ll <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE R S) FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ } <br /> CUBIC YARDS <br /> II hereby certify that the above named material"has been <br /> accepted and to the best of my knowledge the foregoing DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> is true and accurate. <br /> DISPOSE OTHER <br /> REMARKS ❑ SOIL <br /> ❑ CONSTRUCTION t <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGE DATE <br /> ❑ WOOD ` <br /> ❑ ASH ? <br /> t ❑ SPECIAL OTHER <br /> SCHEDULING B►AUST BE MADE PRIOTO 60 P.M.THf�DAY PRIOR TO EXPE TED:ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL.O ING DAILY DELIVERIES MUST BE CHEDULED WITH THE LANDFILL THE DAY BEFORE. ; <br /> Rev 11/09 NS-024 GENERATOR COPY- MANIFEST# �, <br />